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conferenceseries
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Volume 05
Neonatal and Pediatric Medicine
ISSN: 2572-4983
World Pediatrics 2019
December 04-05, 2019
December 04-05, 2019 | Barcelona, Spain
32
nd
World Pediatrics Conference
Fulminant hepatic Failure with Endophthalmitis
Meghana Nannapaneni
Kims Hospital and Research Centre, India
Introduction:
Vision an important sense organ for every person. A disease can be so threatening that it can take
away a child’s vision. In this report we see how a liver pathology can effect eye (endophthalmitis) liver an endocrine
gland required for many functions of the body. Failure of it can be acute or chronic or fulminant. Fulminant hepatic
failure is defined as condition in which coagulopathy and encephalopathy occurs within 8 weeks of onset of liver
disease, in a patient with no previous liver disease, biochemical evidence of liver injury, coagulopathy not corrected
by vitamin k administration, INR>1.5 with encephalopathy, INR>2 without encephalopathy are criteria proposed for
diagnosis. Endophthalmitis infection of inner eye (vitreous and anterior chamber) can be exogenous or endogenous.
Exogenous is because of external trauma, foreign body, post-surgery, that can cause bacterial or fungal infection.
Endogenous endophthalmitis is because of hematogenous spread usually seen in immune compromised or children
on steroid therapy etc.
Case Report:
A 4 year old child came with complaints of fever since 11days, convulsions since 5 days sudden onset,
GTCS type lasting for 10 to 15 mins, 2 to 3 episodes per day, vomiting since 2 days. on examination child was not
consciouswithaGCSof E2V1M4, pupilsmiddilated, vitals- PR-102/minRR- 22/min, B.P-100/60mmof hg,TEMP-101
0F pallor present mild icterus present, head to toe examination normal, on systemic examination revealed motor
hypotonicity, reflexes exaggerated, no signs of meningitis. Investigations revealed deranged coagulation profile (INR
– 2.8) and raised liver enzymes, raised ammonia levels, with increased total counts, negative for all hepatic viruses,
lumbar puncture normal, MRI was normal, immune globin levels normal, ANA profile normal. With anti-oedema
measures and NAC infusion antiviral acyclovir therapy and symptomatic treatment, gradually child improved gcs
normal but there was persistent fever and redness of eye developed on 3
rd
day of admission, on ophthalmic evaluation,
redness of conjunctiva, hypopy on, it was proved that child had endogenous endophthalmitis of right eye, for which
core vitrectomy was done and placed with an artificial prosthesis, now the child is blind in one eye. A unusualcase of
fulminant liver failure with endogenous endophthalmitis.
Discussion:
Fulminant hepatic failure is life threatening condition. And an unknown and rare complication seen in
this condition is endogenous endophthalmitis, a study done by change sue showed the association of endopthalmitis
with pyogenic liver abscess, studies have shown association between staph aureus and liver infections, also how staph
aureus can cause endophthalmitis. So now that a rare case scenario is seen it is duty of doctor to be well aware of the
complication when a liver pathology is involved. That could save any limitation of child’s health and vision.
Meghana Nannapaneni, Neonat Pediatr Med 2019, Volume: 05